ow many times have you had, or heard, these conversations?
“I know I’m carrying extra weight, but I just can’t lose it.”
Or:
“I lost twenty pounds last year, but I’ve gained it all back and then
some.”
Or:
“My doctor just told me that if I don’t watch my diet and start exercising, I’m on my way to developing diabetes.”
This cookbook has been written to end those conversations. It will
teach you to reorient your food life and your life in general. It will help
you feel better, live healthier, be more productive, and—believe it or
not—lose weight without dieting. You will be able to do this by taking
advantage of the hormones that control energy balance and “satiety,” the
feeling of being full.
Drafted with my dear friend, chef Cindy Gershen, these dishes are
down-to-earth, decidedly easy, and delicious. The recipes either minimize or eliminate the ingredients that do damage to our bodies and our
health: fructose (the sweet molecule that makes up refined sugar); refined
carbohydrates; and processed (fiberless) foods of all kinds. They emphasize ingredients that will help your body recalibrate how it uses energy

||

9781594632945_FatChanceCook_TX_p1-319.indd 1

1

10/30/13 9:39 AM

and stores fat: whole grains, whole vegetables (peels and all!), fiber,
omega-3 fatty acids, and high-quality protein. And here is a huge plus:
most of them can be made in less than thirty minutes of active cooking
time.
These recipes have not been pulled out of thin air. They are based on
the science I outlined in my first book about the obesity and diabetes
pandemics, Fat Chance: Beating the Odds Against Sugar, Processed Food,
Obesity, and Disease. They have been drawn from the more than thirty
years of experience that Cindy has had as a successful restaurateur and
caterer in the San Francisco Bay Area, where we both live.

WHY THIS COOKBOOK?
Frankly, you need this cookbook, no matter what your weight. It’s not
just because the way most of us are eating today is making us fat. Even
more alarming, the Industrial Global Diet is making us seriously ill. As
I explain more fully in Fat Chance, 40 percent of normal-weight Americans suffer from the same diseases as the obese: type 2 diabetes, lipid
disorders, hypertension, heart disease, cancer, and dementia. Being thin
or normal weight is not a Get Out of Jail Free card.
This affects all of us, doctors included. For instance, my friend, colleague, and noted surgeon turned nutrition scientist Dr. Peter Attia discovered that he was prediabetic, even though he is young, slender, and
exercises three or four hours a day. Dr. Attia recounted his personal experience with prediabetes in a TEDMED talk: http://www.ted.com/talks/
peter_attia_what_if_we_re_wrong_about_diabetes.html. He lost forty
pounds and reversed his prediabetes with improvements in his diet.
The bottom line is that the Industrial Global Diet is killing people
while bankrupting the American medical enterprise. If we do nothing in
America, Medicare will be broke by 2026 due to the enormous burden of
such chronic metabolic diseases as diabetes. And America exports its
diet around the world to the detriment of both developed, and developing, countries. It has to stop. But it won’t stop until you make it stop.
Change will not come from the food and diet companies. It will not
2

||

T H E FAT C H A NC E C O OK B O OK

9781594632945_FatChanceCook_TX_p1-319.indd 2

10/30/13 9:39 AM

come from restaurants or supermarkets. You and your family will drive
this change, cooking together in your own kitchens. Spatulas and spoons
are the first line of defense in the war against bad food. Change starts at
home. The food industry, like any industry, must be responsive to its
customers. If you don’t buy it, they won’t sell it.
We’ve lost an entire generation of cooks to our fast food culture.
Cooking is a skill passed down from parent to child. If your mother
doesn’t teach you, where are you supposed to learn to chop onions, or
cream butter, or make salad dressing? American high schools used to
teach home economics, and that’s gone too, in the name of education
cutbacks and No Child Left Behind (which is really No Child Moving
Forward and No Teacher Left Standing). The majority of kids growing
up today have never boiled water, not even in a microwave. Kids create
a dish from scratch? As they say in Brooklyn, my hometown, “Fuggedaboutit!”
If you don’t know how to cook—and a 2011 survey found that nearly
one-third of Americans don’t—fear not. These recipes do not require
exotic spices or pricey equipment or hours of prep time. All of them can
be made with basic kitchen tools, with nothing more exotic than a
blender, in less than half an hour of active cooking time. They have to be:
They were tested by Cindy and her high school students at Mount Diablo
High School in Concord, California, where she teaches healthy cooking
and responsible eating. If kids can make these recipes in less time than a
school period, you can too! And if high school students, who are notorious for not eating anything healthier than Flamin’ Hot Cheetos and a
corn dog or drinking anything healthier than a Starbucks Frappuccino,
can enthusiastically consume their own creations made by their own
hands, you can too! In all honesty, your lives may depend upon it.

WE’RE ALL GETTING
FATTER AND SICKER
If you doubt the seriousness of this epidemic, consider these signs of the
Dietary Apocalypse: Nearly 70 percent of Americans are overweight;
C O OK OR BE C O OK E D

9781594632945_FatChanceCook_TX_p1-319.indd 3

||

3

10/30/13 9:39 AM

30 percent are obese. In 1980, only 5 percent of children scored above the
95th percentile in body mass index (BMI), the standard way of gauging
healthy body weight. Today, a whopping 20 percent of kids score above
the 95th percentile. In 1980, there were almost no adolescent type 2 diabetics. Today, there are 40,000. More than 8 percent, or approximately 25
million, Americans have diabetes today. By 2050, it is predicted that onethird of Americans will be diabetic.
This problem is not limited to rich, overprivileged countries like
America. The World Health Organization has found that the percentage
of obese humans worldwide has doubled in the last twenty-eight years.
Globally, the obese now outnumber the undernourished by 30 percent.
Fifteen years ago it was the other way around. Every country, even developing ones, has seen an uptick in obesity rates over the last decade. World
authorities now consider obesity and its associated diseases to be a greater
threat to human health than are smoking or infectious diseases.
Consider the magnitude of this change. And you know the really
amazing thing? This massive, and I mean massive, upending of our food
life has happened in just three decades.

IT’S NOT YOUR FAULT
Why do I care so much about getting people into their kitchens to cook
healthy food? I’m a pediatrician. It’s my job to care. Specifically, I am a
pediatric endocrinologist, which means that I care for children who have
hormonal imbalances. Every day I see the misery that results when the
body’s systems for maintaining and storing energy go haywire. It’s my
job to take care of kids who have become obese because of brain tumors,
hormone excesses or deficiencies, muscle weakness, or other problems.
They are tragically overweight and develop chronic metabolic diseases at
frighteningly early ages.
But it’s not their fault. And it’s not your fault. Everyone thinks that
obesity is a matter of personal responsibility. That explanation just does
not cut it. Here are six reasons why your fat is not your fault.

4

||

T H E FAT C H A NC E C O OK B O OK

9781594632945_FatChanceCook_TX_p1-319.indd 4

10/30/13 9:39 AM

1. Obesity Is Not a Choice. The quality of life for obese children is the

same as for children on cancer chemotherapy. Obesity is not something to which people, especially children, aspire.
2. Diet and Exercise Don’t Work. Everyone can name a celebrity who
has lost weight, but the overwhelming majority of us ordinary folk
fail in our weight loss efforts. Even if we are successful for a while,
we gain it back in short order.
3. The Obesity Epidemic Is Now a Pandemic. This is not an American problem, an Australian problem, a British problem, or a Japanese problem. This is a global problem. Around the world, we are
all eating the Industrial Global Diet.
4. Even Animals Raised in Captivity Are Getting Fat. Livestock animals drink the same water and breathe the same air that we do. We
don’t yet know why this is happening to these animals, but it
argues in favor of some sort of environmental insult to which all
life on the planet is now exposed.
5. The Poor Pay More. The poor often don’t even have supermarkets,
let alone access to healthy food. Can a person exercise personal
responsibility if there’s no healthy choice available?
6. The Greatest Rate of Increase in Obesity Is in the Youngest

Children between the ages of two and five have experienced the greatest rate of weight increase in the last decade. It is
impossible to assign personal responsibility, or free choice, to this
age group. We even have an epidemic of obese six-month-olds.
Infants don’t diet or exercise.

Patients.

For various reasons, the complicated system that regulates energy in our
bodies—the nerves, hormones, and brain structures that determine what
we eat, how much we eat, and whether our body stores that energy as fat
or uses it for the business of living—has gone haywire.

C O OK OR BE C O OK E D

9781594632945_FatChanceCook_TX_p1-319.indd 5

||

5

10/30/13 9:39 AM

IF WE’RE ALL DIETING,
WHY ARE WE STILL FAT AND SICK?
You might say, “I don’t have a disease. What does all this have to do
with me?”
Well, people around the world are putting on the pounds almost as
quickly as the kids in my clinic. They’re gaining for similar reasons: The
energy regulation systems in their bodies have been thrown out of balance.
But in the case of the general public the cause is not brain tumors or other
medical issues. The cause is bad food. It’s a matter of what’s in the processed
food of the typical modern diet, and what isn’t in that processed food.
Every item in the supermarket screams that it’s “low fat” or “low
carb” or “low calorie.” Everyone has a new, magic solution: Eat low carb!
Don’t eat fat! Eat lots of protein! Drink this powder! Fast every other day!
Count food points! Buy prepared diet food! Eat wild food! Eat raw food!
Juice your food! Eat only greens! Take this pill! Take that shot! Have your
stomach stapled!
You might ask yourself why we think we have it right. Because we are
not saying any of those things. We’re not proposing a magical solution.
We’re proposing a sensible solution.
I ask you: Have you seen anyone suddenly shed pounds and keep
them off for more than a year or two with any of these miracle weight loss
systems? Aside from bariatric surgery (which only works in about twothirds of patients), everyone else loses for the first six months, and then
the weight slowly returns over the next six months.

BIG FOOD’S NOT SO SMALL SECRETS
Here are some other things that the food and diet industries don’t want
you to know:
• A calorie is not a calorie. The Coca-Cola Company’s 2013 video
“Coming Together,” states: “Beating obesity will take action by all of
6

||

T H E FAT C H A NC E C O OK B O OK

9781594632945_FatChanceCook_TX_p1-319.indd 6

10/30/13 9:39 AM

us, based on one simple common-sense fact: All calories count, no
matter where they come from, including Coca-Cola and everything
else with calories . . .” In other words, “a calorie is a calorie.”

This is just not true.
The fact is that different calories are metabolized differently, and
how those calories are metabolized and where they go have everything to
do with what diseases you might develop. You cannot eat 1,500 calories
of jelly beans each day, lose weight, and be healthy. Your body uses and
stores fuel—calories—very differently depending on the quality of those
calories.
Because: A calorie is not a calorie.
• It’s the insulin, stupid. If you eat a steady diet of high-sugar, lowfiber, low-quality protein (burgers/chicken nuggets/pizza) and refined grains, you will jack up your insulin levels big-time. That drives
energy storage into fat cells, makes fat in your liver, and makes you
feel very tired as your energy is diverted away from your muscles and
your brain.
• On the other hand, if you eat low-sugar, high-ﬁber, high-quality
protein (eggs, ﬁsh, lean meats) and whole grains, your insulin
response will be much lower. You won’t shunt energy into fat cells.
Your body’s energy systems will stay in balance. You will not only
lose or maintain your weight, you will also feel better. In Fat Chance,
I outlined the science behind these statements in great detail. I’ll
give you a quick summary of it below.
• It’s not about obesity. The food industry would have you believe it’s
about obesity. Then they can blame your love handles on your lack
of discipline, or automobiles, or television, or power lawnmowers, or
the lack of sidewalks in our towns, or the lack of P.E. in our schools.

But guess what? Thin does not necessarily mean healthy. Someone
who looks quite thin might have a lousy diet and have “visceral fat,” that
is, fat around the internal organs, putting him as much at risk for disease
as someone who’s obese. That’s the case for as many as 40 percent of the
C O OK OR BE C O OK E D

9781594632945_FatChanceCook_TX_p1-319.indd 7

||

7

10/30/13 9:39 AM

normal-weight population. Sure, we should all strive to maintain a
healthy weight. But focusing only on weight loss is the wrong approach
to our problems.
• We live in a toxic food environment. Our bodies are hardwired to
eat high-calorie food when it’s available. And our brains are hardwired to like sugar. A lot. Studies show that you must introduce a
savory food to an infant an average of thirteen times before he or she
will accept it. But if it’s a sweet food, you only have to introduce it
once. Liking sugar is built into our DNA—because there are no
foods in nature that are both sweet and acutely poisonous. Th is was
the signal to our ancestors that a given foodstuff was safe to eat.

Today highly sweetened foods are immediately available everywhere
you go. Plus sugar is addictive—weakly so, like alcohol, but addictive
nonetheless. The food industry has hijacked these two phenomena for
their own use. That’s why more than 80 percent of the 600,000 food items
in the American food supply are spiked with added sugar.
• It’s not your fault. When you start to lose weight your body’s starvation response kicks in and the hormone leptin drops. This makes
you both hungrier and less energetic, defeating your best intentions.
Our bodies are hardwired to hang on to stores of fat for times of
famine. But today, in most high- and middle-income nations, times
of famine never come. The problem is that the Industrial Global
Diet, by driving insulin higher, messes up the body’s finely tuned
system for regulating energy.
• Your fat is not your fate, provided you don’t surrender. Not surrendering means we’ve got to start cooking, people. We need to completely rethink our relationship to food and to the food industry. We
need to embrace food and yet be skeptical of the industry that supplies it. That’s why we wrote this cookbook.

8

||

T H E FAT C H A NC E C O OK B O OK

9781594632945_FatChanceCook_TX_p1-319.indd 8

10/30/13 9:39 AM

WHAT IT’S REALLY ABOUT:
“METABOLIC SYNDROME”
Though it sounds pretty grim, it’s not hopeless. We just need to understand what we’re doing to ourselves and what the food industry is doing
to us. And to understand that it’s necessary to outline just a bit of science. This is a cookbook, not a textbook. If you want to understand the
science in detail, the complete picture is sketched out in Fat Chance.
This is what you need to know: Obesity is not a character flaw; obesity is not a behavior; obesity is not a disease (despite the American
Medical Association declaring it one). Obesity is not a defect in energy balance (calories in/calories out). Rather, obesity is a defect in
energy deposition—where excess energy is stored—that occurs because
of changes in biochemistry and hormones that are caused by bad food.
Other downstream effects of obesity include sleep apnea, gallstones,
and problems with your joints and feet. If you carry a lot of extra pounds,
you put yourself at higher risk for all of these conditions. And, not surprisingly given the obesity rates, all of these medical problems have
become more common in the last thirty years. They all increase the risk
of early death.
This is not just a personal crisis for the people unlucky enough to
carry lots of extra pounds. It’s a financial and political crisis as well. All
the diseases caused by excess body fat result in at least $192 billion in
medical bills in the United States alone. The 2012 bills for diabetes and
dementia in the United States were $245 billion and $200 billion respectively. The global cost runs into the trillions. That doesn’t even take into
account the lost productivity and the sheer human misery generated by
these diseases. There’s simply not enough money to pay for it all.
Those extra pounds may take a toll on our vanity, but even more
serious are the medical conditions that “travel” with obesity. These diseases are known as “metabolic syndrome.” They include, but are not limited to: type 2 diabetes, fatty liver disease, high blood pressure, lipid
problems, heart disease, polycystic ovarian disease, cancer, and dementia. All of these are “chronic metabolic diseases” that occur due to inefC O OK OR BE C O OK E D

9781594632945_FatChanceCook_TX_p1-319.indd 9

||

9

10/30/13 9:39 AM

fective energy processing, and can happen in normal weight people as
well. Obesity is not the “cause” of these diseases; rather, obesity is a
“marker” for these diseases. When we tackle the cause, toxic food, both
the diseases and the obesity will get better, no matter what your weight.

SCIENCE FOR THE COOKBOOK CROWD
ENERGY STORAGE AND INSULIN

Lloyd Blankfein, the president of Goldman Sachs, recently stated, “The
only job of business is to make money.” Not the primary job, the only job.
Explains a lot, right?
The physiologic counterpart of this concept is “The only job of the
pancreas is to store energy.” The pancreas makes enzymes that break
down food into smaller nutrient molecules. The pancreas also makes
hormones like insulin, which escorts the energy from food into fat cells
for storage.
It makes sense that the quest for, the regulation of, and the storage of
energy—that is, calories—is one of the most important things that the
body does. After all, if you don’t store energy, none of the other processes
of life can happen: no digestion, no breathing, no movement, no thought.
None of it happens without calories. And insulin is the way the calories
get where they need to go. Insulin shunts glucose and fatty acids to fat
cells. It stores amino acids in muscle. It tops off the liver’s glucose stores
as “glycogen,” or liver starch. Insulin shunts energy from the blood into
fat cells.
Here’s the key takeaway fact: Insulin makes fat. More insulin,
more fat.
Calories come from various kinds of foodstuffs, from carrots to cheesecake to Coca-Cola. The calories arrive at the stomach and then the small
intestine, where foodstuffs are broken down into smaller components. The
liver has first dibs on all of these nutrients. Whatever the liver can’t take up
goes into general circulation in your bloodstream. When bloodstream glucose levels rise quickly, the pancreas releases the insulin to store the excess.
10

||

T H E FAT C H A NC E C O OK B O OK

9781594632945_FatChanceCook_TX_p1-319.indd 10

10/30/13 9:39 AM

ENERGY BALANCE AND LEPTIN

On top of the energy storage system is another complex system that’s
supposed to signal when you’re hungry and when you’re full. A structure
at the base of your brain, the hypothalamus, acts like a traffic cop, monitoring what’s going on and directing the various hormonal systems of
your body.
The hypothalamus reads what’s happening through the blood signals it gets: the hormones insulin and leptin. Insulin tells the hypothalamus when there are excess nutrients that need to be stored. Fat cells
produce a different hormone, leptin, that tells the hypothalamus whether
there are enough energy stores on board in the first place. In response to
these signals, the hypothalamus tells your body whether you need more
or less energy, whether you need to eat, or whether you need to push your
chair from the table.
When these systems operate as they should, you feel hungry when
your brain senses that you’re running low on calories, and you feel full
when you have had enough calories. When you need to expend energy,
you have it on board. Things stay mostly in balance; you feel good and
you maintain a stable weight.

TOO MUCH, TOO FAST

But what happens when you eat a meal of processed food, say, a Big Mac,
super-size fries, and a full-sugar Coke? Or, what happens when you eat
what may seem a “healthier” option, such as pasta with packaged tomato
sauce, salad and croutons with bottled dressing, and ice cream for dessert? That’s when your finely balanced energy system starts to run off
the rails.
That fast food meal (or the home-cooked meal made with processed
ingredients) delivers a huge burst of nutrients into your upper gut: boatloads of glucose, fructose, fats, and proteins. Because they’ve already
been partly processed and because there is no fiber to slow down its
absorption, these nutrients race through the stomach and small intestine. These organs absorb the nutrients very quickly, bringing everything
C O OK OR BE C O OK E D

9781594632945_FatChanceCook_TX_p1-319.indd 11

||

11

10/30/13 9:39 AM

to your liver all at once. There, your liver cells get overwhelmed, and turn
the excess into liver fat. The pancreas gets the signal that the liver is sick
and chugs out more insulin to make the liver do its job. This drives energy
into fat cells for storage, making your body weight go up.
So what do you think happens if you eat processed or fast food regularly, day after day, year after year? Excess insulin means excess fat.
Excess insulin also means that your brain can’t tell if your leptin is working. If your brain can’t see your leptin, your brain thinks it’s starving,
and that makes you feel hungrier. Now you are in a vicious cycle: The
more you eat, the higher your insulin goes, and the more your brain
thinks it’s starving.

HOW YOUR CELLS GET SICK

At the cellular level, the avalanche of energy and nutrients overwhelms
your body’s cellular power generators, called “mitochondria.” When the
mitochondria get overloaded they have no choice but to turn the extra
energy into liver fat, making your liver even sicker. That makes you fatter, lazier, sicker, and you don’t even know where all these problems came
from. How can all this be happening when you’re dieting, buying “low
fat,” and all the rest? Now you have “metabolic syndrome.” Now you are
losing years of your life as your cells and your body age more quickly.
What the science shows is that obesity is not the result of aberrant
behaviors. Rather, obesity is the result of the nutritional alterations that
drive our insulin levels higher. Gluttony and sloth are not the cause of
the rapid global rise in obesity. Rather, they are the symptoms.
With a few rare individual exceptions, that’s the biochemical and
hormone situation for the 1.5 billion overweight and obese people on the
planet. And it’s a problem for a sizeable proportion of normal weight
people too. The majority of people today, regardless of weight, produce
twice as much insulin for the same dose of glucose as people produced
thirty years ago. Even if they’re eating about the same amount as the
generation before them, they’re making more fat in response. That means
things are getting worse just by doing nothing. And that’s what we’re
seeing on the streets, in our homes, and in my clinic.
12

||

T H E FAT C H A NC E C O OK B O OK

9781594632945_FatChanceCook_TX_p1-319.indd 12

10/30/13 9:39 AM

THE NOT-SO-USUAL SUSPECTS
Stress, environmental factors, lack of sleep, and many other things feed
into the obesity pandemic by changing various biochemical pathways.
And each person’s insulin and leptin situation is slightly different. But
really, the major cause of our ballooning waistlines worldwide boils
down to two words: “toxic food.”
The modern diet is larded with things that upset our energy balance and our health. Here are just a few:

FRUCTOSE

Fructose is the Voldemort of the metabolic syndrome pandemic: stealthy,
ever-present, and bad for the common good. The refined, white sugar
that you put in your coffee or sprinkle on your cereal consists of molecules that have two halves: One half is “glucose,” a minimally sweet substance (think molasses) that all your cells need for energy. The other half
is “fructose.”
Fructose is the sweet stuff. We like it. A lot. But the truth is that our
bodies don’t need fructose. There is not one biochemical reaction in the
body that requires fructose. A technical way to say this is: Fructose is an
energy source, but it is not a nutrition source. You can get along perfectly fine without fructose. Aside from its effects on the pleasure center
of the brain, fructose has lost whatever value it might once have had to
humankind. It’s “vestigial” (a holdover, unnecessary). We don’t need it.
But boy, do we want it.
Does sugar cause weight gain? The data say yes, but not all that much.
Is sugar a cause of obesity? In some people, probably so. Is sugar the cause
of obesity? Not even close. What fructose does is cause metabolic syndrome, and that’s what makes you sick, because your liver has a harder
time metabolizing it. So, instead, the liver turns fructose into liver fat,
and that leads to metabolic syndrome. This drives your insulin even
higher, causing more weight gain. The reverse is also true: when metabolic syndrome improves, your weight will improve of its own accord.
C O OK OR BE C O OK E D

9781594632945_FatChanceCook_TX_p1-319.indd 13

||

13

10/30/13 9:39 AM

Americans now consume an average of 22 teaspoons of sugar each
day, up nearly 50 percent from a generation ago, according to the American Heart Association (AHA). We need to cut that in half, according to
the AHA.
But just cutting out “high-fructose corn syrup” (HFCS) will not save
you. HFCS, honey, molasses, agave syrup, brown sugar, organic demerara
sugar, beet sugar—to your body, these are all the same thing, chemically.
Today, sugar is everywhere: A 2012 report by the magazine Mother
Jones found that a generation ago, Americans spent 11.6 percent of their
food dollars on processed foods and sweets; now, Americans spend 22.9
percent of food dollars on them. And sugar (the sweet stuff ) is in all kinds
of places you might not expect: yogurt, spaghetti sauce, crackers (check
out Wheat Thins), ramen noodles, even hamburger meat!

TRANS FATS

Patented in 1902 and introduced to our food supply as Crisco in 1911,
trans fats are the single most dangerous item in our diet. They increase
the shelf life of every item to which they are added. Bacteria don’t have
the machinery to digest trans fats, so foods with trans fats keep longer.
And guess what? Your mitochondria, those cellular power plants, are just
repurposed bacteria. They can’t digest trans fats either. Rather than being
converted into energy by the mitochondria, trans fats just stick around,
literally: They line our arteries and our livers, causing disease.

OMEGA-6 FATTY ACIDS

These lead to the production of inflammatory compounds, the ones targeted by aspirin. We need some omega-6s to help our immune system
function, but they’re supposed to exist in balance with the omega-3 fatty
acids that fight inflammation. We’re supposed to have a 1:1 ratio between
omega-6s and omega-3s. Today, most of us have twenty-five times more
omega-6s on board than omega-3s. That leads to a pro-inflammatory
state that drives heart disease, diabetes, and cancer.

14

||

T H E FAT C H A NC E C O OK B O OK

9781594632945_FatChanceCook_TX_p1-319.indd 14

10/30/13 9:39 AM

Omega-6s are found in canola and corn oils, and in the meat from
animals that are fed corn and soy. It makes a difference where you get
your protein: Corn-fed beef, chickens fed commercial pellets, and cornfed, farmed fish—all these feed into chronic inflammation in your body.

ALCOHOL

In small amounts, alcohol can be protective against disease, keeping
your system on “alert,” keeping your liver’s detoxifying enzymes “ready
to go,” ready to process the toxic parts of your food. But in large amounts
(more than two drinks per day for a man, one for a woman), alcohol
overwhelms your mitochondria, gets turned into liver fat, and drives
the development of metabolic syndrome. Just look at the “beer belly” of
many adults today.

BRANCHED-CHAIN AMINO ACIDS

These compounds—leucine, isoleucine, valine—are the essential building
blocks of protein. When you are building muscle, these compounds are
good. That’s why body builders take “protein powder.” But when you’re
not building muscle, these amino acids go to the liver mitochondria to get
turned into energy. And when the mitochondria get overwhelmed, they
turn these branched-chain amino acids to liver fat. And liver fat, well, you
get the punch line by now: Liver fat leads to metabolic syndrome.
Branched-chain amino acids occur in many foods, but you find their
highest levels in corn-fed beef, chicken, and farmed (corn-fed) fish.

WHAT’S GOOD FOR BIG FOOD
IS BAD FOR YOU
The packaged, processed foods that make up 80 percent of what’s for sale
at your local Kroger’s, Piggly Wiggly, Walmart, or Safeway are great for
the food companies: They’re cheap. They’re highly profitable. Even better,

C O OK OR BE C O OK E D

9781594632945_FatChanceCook_TX_p1-319.indd 15

||

15

10/30/13 9:39 AM

they keep forever, thus, the ten-year-old Twinkie, the Oreo that never
spoils.
These processed foods have been engineered to make you crave
them. They’re full of sugar, fat, salt, and caffeine. Even worse, the ingredients in processed food make you overindulge once you get your mouth
around them. Though there’s still a robust academic debate about
whether fast food can be addictive, doctors no longer dismiss the idea out
of hand.
Nora Volkow, director of the National Institute of Drug Abuse, has
gone on record supporting the concept of food addiction. Let me tell you
this: After treating obese children for the last fifteen years, I can categorically say there are loads of kids who can’t fend off a Big Mac Attack. The
science says that sugar is addictive, though not in everyone, like alcohol.
But it’s addictive nonetheless. Combine sugar with another addictive
substance, like caffeine, and now you’ve a truly addictive, toxic brew: It’s
called soda.
The food that’s cheapest and most available may be good for the food
companies. For us mere mortals, that food is a health disaster. It’s toxic
at high dose, and we’re overdosed. Most of the food that surrounds you—
in the coffee break room, at the meeting, in the supermarket, at the convenience store check-out, in the movie theater, at street-side stands, at
sports events, and in your own cupboards—is processed and will make
you fat or sick, or both.

TARGET THE BIOCHEMISTRY
TO IMPROVE YOUR HEALTH
So far, medical research has yet to find a pill or a shot that will really fi x
obesity, or metabolic syndrome for that matter. We can treat all the different diseases that travel with metabolic syndrome, but we can’t stop the
cellular damage. Based on how metabolic syndrome occurs (mitochondrial energy overload), there is no obvious drug target, so I wouldn’t hold
my breath waiting for the “magic bullet.” But don’t despair. There really
is hope.
16

||

T H E FAT C H A NC E C O OK B O OK

9781594632945_FatChanceCook_TX_p1-319.indd 16

10/30/13 9:39 AM

In order to reverse obesity and metabolic syndrome, we have to
reverse the damaging biochemistry. That means we need to give the cellular power plants, the mitochondria, a break. We need to stop the liver
overload in order to fi x the insulin resistance. We need to get the insulin
down in order to fi x the leptin resistance, the reason we think we’re hungry even though we’re fat.
Calories are not the target. INSULIN IS THE TARGET.
As long as insulin stays high, the drive to eat and the drive to store
energy cannot get better. Get the insulin down. That’s what my clinic at
UCSF does. That’s what the recipes in this cookbook do. That’s why this
cookbook is different. And that’s why this cookbook is necessary.
Until the food industry reformulates its fare to provide quality, not
quantity, and until the U.S. government stops subsidizing the very foodstuffs that drive disease (corn, soy), the American foodscape is unlikely
to change. In the meantime, how do we lower our insulin? We must start
eating differently, more like our parents and grandparents did. We should
be cooking food that has these things:
• Fiber: Everyone thinks that fiber is the throwaway nutrient. In
fact, fiber is the stealth nutrient. It slows down the rate at which
your body can convert food into energy. High-fiber food is like a
timed-release capsule. It releases energy into your bloodstream at
a slower rate. That way, your mitochondria, and thus your liver,
your pancreas, and your brain—get the energy slower, so they don’t
get overwhelmed. Also, fiber reaches the end of the intestine faster.
That sends a satiety, “I’m full,” signal to your brain sooner, so you
won’t eat as much.
• Omega-3 fatty acids: These are anti-inflammatory compounds that
we need to keep the omega-6s in check. You must eat them; your
body can’t make them. Omega-3s come from algae. Wild fish
eat algae. We eat the wild fish. Yes, wild fish is more expensive than
farmed fish, but many species of farmed fish eat corn. You might
as well eat a steak. Another slightly cheaper source of omega-3s is
flaxseed. You can also buy eggs from chickens that eat feed rich in
omega-3s.
C O OK OR BE C O OK E D

9781594632945_FatChanceCook_TX_p1-319.indd 17

||

17

10/30/13 9:39 AM

• Micronutrients: Some early research suggests that, as we’ve bred bigger and sweeter fruits and vegetables, that produce has become less
nutritious. Some studies suggest that domestic produce has fewer
healthy micronutrients and antioxidants, compounds that combat
inflammation. That’s what’s behind all the calls to eat “wild food.”
You don’t need to forage for your veggies, but you do need to eat
lots of leafy greens like spinach and kale, and lots of fruits and vegetables, peels and all. Supermarket produce will do as well as the
fancy organic kind for your general needs.

EAT “REAL” FOOD
Food writer Michael Pollan has said, “Don’t eat food that your grandmother wouldn’t recognize as food.” We don’t need to go that far. After
all, would Grandma recognize tempeh, tofu, or edamame? Pollan also
has said, “Eat food. Not too much. Mostly plants.” But when you eat
“real” food, the not-too-much takes care of itself. And there are plenty
of plants—corn, soy, refined wheat—that aren’t all that good for you.
No, the science says that we need to get back to basics. We need real,
whole food that we cook at home: whole grains, grass-fed meats, meat
and eggs from free-range chickens, wild fish, whole vegetables and fruits,
peels and all.
Sounds utopian to most. Indeed, the problem is that “real” food is
expensive and considered “specialty” food. This cookbook takes that into
account. These recipes are designed for everyone, including parents in
low-income neighborhoods. You should be able to afford and find the
ingredients in these recipes at most local supermarkets. If you can’t,
demand these ingredients. More on that later.
You aren’t going to find these healthier ingredients in “diet” frozen
dinners. You’re not going to find them in packaged sauces, packaged
cereals, packaged desserts, packaged snacks, or condiments, even those
labeled “healthy.” In fact, if products are labeled “low fat” that often
means that the fat has been replaced with sugar instead.

18

||

T H E FAT C H A NC E C O OK B O OK

9781594632945_FatChanceCook_TX_p1-319.indd 18

10/30/13 9:39 AM

You’re not going to find this kind of real food at McDonald’s, or
at any other fast food chain. Witness what happened to the “McLean
Deluxe,” hamburger meat infused with seaweed. Even though it tasted
pretty good, people would not purchase it. When people go to McDonald’s, they are not going to be diet-conscious. Even if you eat a salad
from the drive-thru, that salad is going to come with croutons and salad
dressing dripping in sugars, trans fats, and omega-6s. In fact, a McDonald’s salad (plus the dressing) may have more calories and sodium than
does a Big Mac. The “healthy” chicken topping the salad will have been
fed corn or soy, because that’s cheaper. So the chicken will be full of
branched-chain amino acids and omega-6s, which leads to—you’ve got
it now—metabolic syndrome.
Dessert should be special, a once-a-week affair. Refined sugar should
be a treat, something to look forward to. It should not be an everyday,
every meal centerpiece. And if you’re going to have dessert, make it fantastic, something to remember. If you can buy it at a supermarket, I
promise you, it’s not fantastic.
Yes, avoiding the sugar and other problem nutrients in processed
food is a little more trouble. Cooking things from scratch may take a little more time. Some items—fresh berries or high-quality meats or fish—
may cost a little more. Would you rather pay a couple extra bucks for
good produce and spend a little more time cooking whole grains? Or
would you rather end up with a lifelong, chronic condition that costs
tens or even hundreds of thousands of dollars, and may even cost you
your life? Think of it this way: it’s your time or your health. Short-term
gain for long-term pain.

THE INSPIRATION FOR THIS COOKBOOK
I started synthesizing the science into these conclusions more than a
decade ago. Long before I gave a lecture that turned into a four-millionplus-hit YouTube video explaining the science and the policy implications of sugar (youtube.com/watch?v=dBnniua6-oM), long before I

C O OK OR BE C O OK E D

9781594632945_FatChanceCook_TX_p1-319.indd 19

||

19

10/30/13 9:39 AM

wrote Fat Chance, long before I appeared on 60 Minutes, NPR Science
Friday, and The Colbert Report, I started speaking to the medical community about the obesity pandemic and the science behind it.
While giving a talk at John Muir Medical Center in 2006, I met
Cindy Gershen. Cindy’s husband, Lance, is a pediatrician, and he had
let her know about the subject of the talk. She came armed for bear. At
first, I thought she was a stalker. Then I realized, no, she was way worse!
She practically held me down kicking and screaming while she extracted
every scientific point I had made to date. Then she said, “Thank you. You
have just scientifically validated everything I’ve learned through experience.” We’ve been best friends ever since.

CINDY’S STORY
In 1981, when Cindy was in her mid-twenties and pregnant with her
third child, she opened her first food business, Sunrise Bakery and Café
in Walnut Creek, California, twenty miles east of San Francisco. After
her son was born, his sleep patterns didn’t let her rest much. So she stayed
up with him through the night and baked pastries, quiches, and breads
for her café. People lined up outside for a taste of that home cooking.
She soon outgrew the café’s space and opened Sunrise Bistro, a block
away from the café. She continued the homemade tradition there, and
expanded it beyond breakfast and snacks to include lunch and dinner
entrées.
Two decades later, the Bistro was still going strong and had added
a catering department. Yet Cindy rarely made it out of the kitchen. Over
the years, she had loaded 210 pounds onto her petite, 5-foot-3-inch frame.
She had thought she was eating healthy food, but still, she had become
obese.
Cindy felt tired, depressed, and ashamed. She told me that, during
her fat years, she had a constant negative feedback loop going in the back
of her mind: “How could she have let her body get so out of whack? What
was wrong with her?” She told me that she would have done anything—
anything—to get rid of the weight.
20

||

T H E FAT C H A NC E C O OK B O OK

9781594632945_FatChanceCook_TX_p1-319.indd 20

10/30/13 9:39 AM

Cindy had tried a million diets: Weight Watchers, fasting, diet
shakes, you name it.
Although she had a wealth of knowledge, she realized she lacked
commitment. One day, Cindy decided not to diet. Instead, she fundamentally changed her approach to food. She kept her portions to reasonable levels. She eliminated snacks. She cut refined flour and refined sugar
out of her diet. She avoided sodas, alcohol, and juice. She ate small
amounts of whole grains, added lean proteins and dairy, doubled her
fruits and tripled her vegetables.
Over six months, Cindy lost one hundred pounds. She felt healthier, more clear-headed, and more energetic than she had in years. As of
this writing, she has kept that weight off for fifteen years.
“Until I heard you talk, I didn’t understand why what I did worked,”
she told me. “And it is so liberating to learn that my problem with weight
did not have its roots in some character flaw.”
In very simple terms, when Cindy cut out added sugar, she broke an
addictive cycle with food and stopped a whole grab-bag of unhealthy
processes in her body: insulin and leptin resistance, misfiring biochemical signals that meant she never felt full, overloaded mitochondria, liver
fat; in other words, “metabolic syndrome.”
When Cindy ate real food rather than processed food, she felt less
hungry because it took her body longer to process the fuel she was putting into it. That has helped her to stick with her new, healthier habits. By
reducing her insulin, Cindy’s positive feedback loop (leptin resistance)
regained its servo-mechanism (leptin sensitivity), and became a negative feedback loop once again, allowing her to lose the weight and keep
it off.
Cindy still gets choked up when she talks about that day when we
met. She understands better than most how painful it is to be severely
overweight: the cycle of self-blame and shame and diet failure and hopelessness. She often says she can’t believe how good she feels now. She
brims with energy. Let me tell you, this grandmother gets more done
before 9 a.m. than most people do in an entire day. I’m an overachiever,
and yet she puts me to shame. She says she still marvels at the revelation
of feeling so good about her body after decades of hating it.
C O OK OR BE C O OK E D

9781594632945_FatChanceCook_TX_p1-319.indd 21

||

21

10/30/13 9:39 AM

Cindy finally reversed her obesity by reversing her biochemistry. She
did it by cooking and eating “real food”—indeed, with many of the recipes you’ll find in this book.

ROB AND CINDY GO ON THE ROAD
Not long after our first meeting, Cindy and I started working together. We
called our events “Eat and Learns.” You can’t just talk to people about the
benefits of “real” food; you have to show them. That means feeding them.
We spoke at retirement communities and political gatherings and
schools and conferences. I’d explain the science, Cindy would tell her
story and the method behind the madness. Then we’d cook a healthy
meal with the audience to show them that it’s not difficult.
We do the same thing in my clinic: We hold a “teaching breakfast”
with the patients and the parents. We’ve learned that you can’t get kids to
change until the parents change, and they won’t change until you show
them four things: 1) Their kid will eat the food; 2) Other people’s kids will
eat the food; 3) They themselves like the food; and 4) They can afford the
food.
Providing all that information offers the best chance of turning a
family around; anything less than that is doomed to failure. And that’s
what we continue to see from all these healthy-eating programs nationwide. Most health and diet regimes don’t work long-term. It’s time for a
change.

CHANGING COMMUNITIES
Emboldened by her scientific understanding of her own story, Cindy
revamped the menus of her restaurant and catering business, cutting
down on sugar and refined flours, adding lots more beans, grains, vegetables, and fruits to her menus.
Gradually, Cindy became a public advocate for healthier food and
healthier lifestyles. She sponsored a “Mayor-A-Thon” to get politicians
22

||

T H E FAT C H A NC E C O OK B O OK

9781594632945_FatChanceCook_TX_p1-319.indd 22

10/30/13 9:39 AM

involved, walking a mile a week with elders at a large retirement community to promote healthier lifestyles. She organized health festivals. She
challenged other restaurants to serve healthier food to their customers.
She started a nonprofit, Wellness City Challenge (wellnesscitychallenge
.org), to promote healthier lifestyles. I agreed to serve on the board of
Wellness City Challenge, and still do. I have also started my own nonprofit, The Institute for Responsible Nutrition (responsiblefoods.org), to
provide the medical, nutrition, and legal know-how to take on the processed food industry. We work together to change communities. Today,
the San Francisco Bay Area. Tomorrow, weâ&#x20AC;&#x2122;re coming to your town.
As Cindy got more and more involved with promoting healthy lifestyles in local communities, she started to work more and more with
schools. She saw kids like those who populate my medical practice at
UCSF: preteens with diabetes, grossly obese teenagers, kids who have
trouble focusing, kids who are hyperactive, kids with constant fatigue.
Cindy felt that many of these problems could be solved if only kids had
the knowledge and the power to change how they eat. Eventually, she
decided that she needed to start teaching these kids about nutrition and
how to cook healthy food.
Cindy got a part-time job as a teacher at Mount Diablo High School,
an underserved, struggling school in the suburban town of Concord,
about ten miles from affluent Walnut Creek, where she lives and operates
her businesses. Cindy says she is blessed with the people who staff her
businesses, so she could run the restaurant and catering operations while
only checking in for a few hours each day. She was free to become a parttime high school teacher.
Think about this: Cindy gave up a lucrative day job that she loves to
take on the biggest challenge in America: toxic food. Talk about being an
overachiever!

KIDS WILL EAT THIS FOOD AND LIKE IT
During the 2011 to 2012 school year, Cindy taught one class of about
twenty high school juniors how to cook healthy food. Together, they fed
C O OK OR BEÂ C O OK E D

9781594632945_FatChanceCook_TX_p1-319.indd 23

||

23

10/30/13 9:39 AM

their entire class and offered free breakfast and lunch to all the teachers
who wanted to participate. The kids ate food that everyone else says teenagers won’t eat: whole foods low in sugar and high in fiber and nutrients. Dessert was fruit, not cakes and cookies. She has continued these
efforts, adding more classes through the 2012 to 2013 calendar and into
the current school year.
I have visited Cindy’s classes many times, and what I’ve seen there
gives me so much hope for the future. Some of Cindy’s students have lost
fift y, even a hundred pounds, eating the dishes you’ll find in this cookbook. Teens who once had trouble focusing, who were once behavior
problems, who once had no direction have become energized and ambitious. Cindy has changed their food and empowered her charges for the
rest of their lives. The mantra of the class: “Change the Food, Change the
Future.”
When we were choosing the recipes for this book, Cindy enlisted
students from her classes to help test the recipes at a scale more appropriate for a home kitchen, rather than for a restaurant or a school cafeteria. After they cook, the kids eat their creations: servings of shaved,
roasted Brussels sprouts; kale chips; and quinoa. When I’ve visited Cindy’s classes, I have witnessed it again and again.
Look, I’m a pediatrician. I get to see other people’s kids all day. And
I’m telling you this: You have never met a more positive, friendly, alert,
and engaged group of young people. No attitudes or obsessing over smart
phones or gang colors here. These kids are armed with survival skills,
and they’re not just surviving—they’re thriving.

YOU CAN DO IT TOO
When they see my videos on YouTube or read Fat Chance, people frequently e-mail me. The most common question, is, “So what do we do
now?” Cutting out sugar and the bulk of refined flours, making things
from scratch—all that sounds so difficult. It sounds so complicated. It
sounds so bland. It sounds so un-fun.
Both the food and the diet industries would like you to believe
24

||

T H E FAT C H A NC E C O OK B O OK

9781594632945_FatChanceCook_TX_p1-319.indd 24

10/30/13 9:39 AM

just that. The reason Cindy and I decided to write this book together is
that it’s just not true. It’s another misleading, corporate dogma to be
debunked.
With new knowledge, a new approach to food, and a few basic cooking techniques and recipes, you can change your life based on the science
I outlined in Fat Chance. The food you make can be delicious, it can be
fast, and it can be fun.
The steps you need to take are not all that complicated, and it’s our
hope that this book will show you that’s so. You don’t need to diet. In fact,
if you ever go on a diet again, I will have failed. You can lose weight and
keep it off. Even more important, you can reverse the damage of metabolic syndrome. You can live a longer, happier, and healthier life. And
ultimately, it’s cheaper too. Let’s get cooking!

C O OK OR BE C O OK E D

9781594632945_FatChanceCook_TX_p1-319.indd 25

||

25

10/30/13 9:39 AM

HOMEMADE “SAUSAGE”
= Serves: 6

= Active time: 10 minutes

= Serving size: 3 ounces

= Total time: 25 minutes

This isn’t technically “sausage,” because it does not have a casing. But
it tastes like breakfast sausage. Even better, it has no “mystery meat,”
no preservatives, no added sugar, no chemicals. It’s quick, simple, and
delicious. You can slice it, freeze the slices on a cookie sheet, then pop
them into a plastic bag to fry up as needed.
Substituting turkey in savory foods is always a dicey proposition,
because ground turkey doesn’t have the fat of other meats, and
therefore it has less ﬂavor. So it’s all about the seasoning. Season it
right, and nobody cares: the more complex the ﬂavors, the better.
And fennel is a fantastic seasoning to extend a savory dish.

When you’ve got bananas that have gone too ripe for your taste, peel
them, pop them in a freezer bag, and save for recipes like this.
Many banana recipes go over the top with sugar. This recipe uses
whole-grain ﬂours and cuts the sugar in half. This bread is so rich,
many people mistake it for brownies. For everyday meals, leave out
the chocolate chips. Save the chips for special occasions.